Article
Selective dorsal rhizotomy for spastic cerebral palsy
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Authors
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M. Memet Özek
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Acibadem University, School of Medicine, Istanbul, Turkey
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Murat Basarir
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Acibadem University, School of Medicine, Istanbul, Turkey
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Özcan Kalkan
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Acibadem University, School of Medicine, Istanbul, Turkey
| Published: | May 13, 2014 |
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Outline
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Objective: Surgical and medical interventions have been previously used to minimize tone in children with spastic cerebral palsy (CP). This article's objective is to assess the current status of selective dorsal rhizotomy (SDR) based on a review of literature and personal observations from 480 cases of patients with spastic cerebral palsy (CP). Operative technique involves variability in terms of level of exposure, electrophysiological guidance, and extent of rhizotomies.
Method: During the period of 1995-2012 we have operated on 480 patients with spastic diplegic CP and spastic quadriplegic CP in which lower extremities were more severely affected than the upper extremities. Patients were all evaluated by the same multidisciplinary team at pre- and at 6, 18 months, and 3 years following the surgical procedure. Clinical and demographic data as well as number of rootlets cut and complications were prospectively registered. Deep tendon reflexes and muscle tone were examined (with the modified Ashworth scale). Spasms were classified according to Penn scale and motor function was classified according to the GMFCS and measured with the Gross Motor Function Measure (GMFM), Ambulatory patients were evaluated by motion analysis. Parent's opinions about the children's performance and the amount of caregiver assistance were measured with Pediatric Evaluation Disability Inventory (PEDI).
Results: The mean proportion of rootlets cut in S2-L2 was 56%. Muscle tone was immediately reduced in adductors, hamstrings and dorsiflexors with no recurrence of spasticity over the 3 years. For GMFCS-subgroups I–II, III and IV–V had significant improvements with respect to the capacity of GMFM and PEDI.
Conclusions: SDR is a safe and efficient method in permanently reducing spasticity without causing major side effects. In a group of carefully selected and periodically followed children with spastic diplegia and quadriplegia, it provides functional benefits that last over a period of at least three years following the surgical procedure when given in combination with physiotherapy.
